1. According to Orem, people enter the acute health care setting when they are experiencing either a self-care or a:

a.

dependent-care agency.

b.

community-care agency.

c.

dependent-care deficit.

d.

community-care deficit.

ANS: C

At various times in life, a person will have a health care demand, either a self-care or dependent-care demand that exceeds his or her self-care agency. When this happens, the person is said to have a self-care or dependent-care deficit. When this deficit is such that the person needs the specialized training of health care professionals, the person enters the health care setting and engages in a collaborative relationship with the RN and other health care team members. All other answer options are incorrect.

DIF: Cognitive Level: Knowledge REF: Page 285

OBJ: Discuss the theoretical framework for managing in secondary care.

TOP: Managing Secondary Care

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. In the acute care environment, what is(are) the primary role(s) of the RN?

a.

Ensure more independence in self-care ability.

b.

Avoid complications as the patient progresses through the illness state.

c.

Change the medical plan of care according to the RNs assessments.

d.

Both a and b are correct.

ANS: D

Acute health care requirements vary with the progress of the disease either toward a cure or through complications that can occur. The RN uses information from many different sources to identify potential and actual problems with the patients progress. The overall focus is to prevent complications while promoting a higher level of health. Changing the medical plan of care is not the role of a nurse.

3. A nurse writes the diagnosis of potential for infection for a postoperative patient. The charge nurse makes certain not to place a patient with a diagnosed infection in the same room with the fresh postoperative patient. The nurse does this to manage which of the following?

a.

The potential for noise in the room

b.

The potential for patient complaints related to odors

c.

The physical environment of the secondary health setting

d.

The social environment within the secondary health setting

ANS: C

Much within the environment of the acute care setting has the potential to extend the patients length of stay by introducing unexpected complications. Moving the patient through the acute care setting effectively and safely requires the RN to pay attention as the patient responds to the environment, as well as to anticipate the potential effects of the environment, including staffing issues. A common nursing diagnosis is potential for infection, and nosocomial, or hospital-acquired, infection is just one of the problems that competent nursing management can prevent. The charge nurse can manage this environmental concern by basing bed assignments on the diagnoses of the patients and then subsequently basing caregiver assignment on qualifications. The potential for noise, the potential for complaints, and the social environment have nothing to do with infections or the potential for infections.

4. After being diagnosed with cancer, the patient appears angry. At this point it would be appropriate for the nurse to assess for which kind of distress?

a.

Environmental

b.

Developmental

c.

Physical

d.

Spiritual

ANS: D

Patients facing stressful health carerelated events may also experience spiritual distress. Illness states can place a patient in a position that forces consideration of the fragile nature of life. Resulting from a potential life-or-death experience or a life-changing event, spiritual distress may take on many manifestations. Much as in the grief process, the patient may display anger, blame, bargaining, or denial or may overtly cling to a spiritual guide. RNs assess for spiritual distress and implement interventions that will help the patient cope, such as facilitating the patients spiritual connection either through a referral or just by respecting personal wishes. Environmental, developmental, and physical distresses are not typically related to chronic or terminal disease situations.

DIF: Cognitive Level: Analysis REF: Page 288

OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Spiritual

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. Some cultures see personal touching as an insult unless you are intimately related. In the acute care setting, the need for touching to administer care may produce what within the patient?

a.

Cultural strain

b.

Impaired functioning

c.

Cultural insult

d.

Increased self-care deficit

ANS: A

Cultural strain may be manifested in the patients responses to the surroundings or to the plan of care. One culture-derived concept is personal space, the distance surrounding a person considered to be part of his or her identity. Personal space is generally thought to be between 1 and 3 feet around a person, depending on cultural upbringing and personal interpretation. A breach of that space by objects or another person may cause discomfort and stress. Impaired functioning, cultural insult, and increased self-care deficit are not discussed in relation to cultural needs and influences.

DIF: Cognitive Level: Analysis REF: Page 289

OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Culture

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

6. By allowing the ICU patients family to visit as often as the patients condition will allow, the nurse is considering which type of need within the patient and his family?

a.

Trust

b.

Social support

c.

Environmental

d.

Dependence

ANS: B

The acute care facility is a stressor to both patient and family. It can isolate the patient from the social support systems that he or she has in place. The needs of the family may not appear to be a priority for the nurse in planning the patients care, but they must be considered for the patient to receive ample social support. The rest of the family is facing some of the same stresses as the hospitalized family member. Trust, environmental, and dependence needs are not related to social needs and influences.

DIF: Cognitive Level: Analysis REF: Page 290

OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Social

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. Discharge planning requires all of the following except:

a.

assessing the patients plan of care to determine whether the outcome criteria are met.

b.

evaluation of whether the patient and family can continue with the necessary interventions or whether they need assistance.

c.

obtaining specific orders from the physician to begin the process of discharge planning.

d.

assessing the level of the patients understanding with regard to his or her illness state and treatment regimen.

ANS: C

Discharge planning requires assessing the patients plan of care to determine whether the outcome criteria are met. If a need exists for continuation of the plan of care, then the RN must evaluate whether the patient and family can continue with the necessary interventions or whether they need assistance. If the patient and the family are able to continue the plan of care, discharge teaching with regard to the continued care is needed. Discharge teaching will require the RN to assess the level of the patients understanding with regard to his or her illness state and treatment regimen. There is no need to obtain an order to begin this process.

8. The extended care meant to provide health restoration after discharge from an acute care facility is also known as _____ care.

a.

primary

b.

tertiary

c.

acute

d.

quaternary

ANS: B

The purposes of tertiary care are to provide health restoration and maintenance and to continue with health promotion. The purpose of primary care is not discussed. The purposes of acute care include prevention of complications and adverse effects of disease and prolonged disability through early diagnosis and treatment and rehabilitation in the event of disfigurement and disability. Quaternary care is not discussed.

DIF: Cognitive Level: Knowledge REF: Page 292

OBJ: Define the purposes of tertiary care. TOP: Tertiary Care

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

9. The health maintenance focus for the patient in tertiary care is to:

a.

regain or attain as much independence as possible.

b.

extend the time in tertiary care as long as possible.

c.

ensure total independence with self-care.

d.

avoid acquired infections while in the tertiary facility.

ANS: A

The health maintenance focus of tertiary health care is to ensure that the patient regains or attains as much independence as possible. Time in tertiary care is only as long as necessary. The purposes of tertiary care are to provide health restoration and maintenance and to continue with health promotion. It is recognized that patients will require some level of dependent care. Avoiding infections in tertiary care facilities is not discussed.

DIF: Cognitive Level: Knowledge REF: Page 292

OBJ: Define the purposes of tertiary care. TOP: Tertiary Care

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. A stroke patient has been discharged from the hospital and requires care at home. Family support includes the patients husband and one adult child who lives 90 minutes away with her family, who helps as often as possible. The husband has had to miss work often and has stopped playing golf weekly to care for his wife. What tertiary care service may be a benefit not only to the family members but to also the patient?

a.

Home health care

b.

Respite care

c.

Hospice care

d.

Extended care

ANS: B

Long-term care of a patient can take a toll on family members. Respite care describes services provided by trained individuals for the care of people with special needs and can be given within the home or through adult day care centers. It is intended to offer the patients family members time off from their dependent-care duties. Home health care services provide assistance for short periods of time after discharge home with a variety of services including physical therapy, respiratory therapy, or occupational therapy. The need for care is generally assessed with an intake interview by an RN case manager. The level of care and treatment are then determined accordingly. Hospice care helps patients and family cope with the end-of-life experience. Patients are referred to hospice when a patient has approximately 6 months or less to live.

DIF: Cognitive Level: Application REF: Page 292

OBJ: Define the purposes of tertiary care. TOP: Tertiary Care

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

11. A patient has endured 3 years of treatment for colon cancer but recently learned that the cancer has spread to her liver and bone. The patient and her family have learned she may have less than 6 months to live and there is nothing medically to consider. What tertiary service can the RN suggest to the patient and family?

a.

Hospice care

b.

Wound care

c.

Home health care

d.

Ostomy care

ANS: A

Hospice care helps patients and family cope with the end-of-life experience. Patients are referred to hospice when a patient has approximately 6 months or less to live. The RN assesses the continued needs of the patient and works with the physician to provide comfort measures for the patient. The goal of hospice care is the patients peaceful and dignified death. Wound care and ostomy care are not discussed. Home health care services provide assistance for short periods of time after discharge home with a variety of services including physical therapy, respiratory therapy, or occupational therapy. The need for care is generally assessed with an intake interview by an RN case manager. The level of care and treatment are then determined accordingly.

DIF: Cognitive Level: Application REF: Page 292

OBJ: Define the purposes of tertiary care. TOP: Tertiary Care

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. A patient has been discharged home after being hospitalized for a fractured foot following a motor vehicle accident. The doctor has ordered physical therapy for the patient to help gain strength and flexibility after the cast can be removed. This patient will likely receive a referral for what tertiary service?

a.

Respite care

b.

Home health care

c.

Wound care

d.

Rehabilitation care

ANS: B

Home health care services provide assistance for short periods of time after discharge home with a variety of services including physical therapy, respiratory therapy, or occupational therapy. The need for care is generally assessed with an intake interview by an RN case manager. The level of care and treatment are then determined accordingly. Respite care describes services provided by trained individuals for the care of people with special needs and can be given within the home or through adult day care centers. It is intended to offer the patients family members time off from their dependent-care duties. Wound care and rehabilitation care are not discussed.

DIF: Cognitive Level: Application REF: Page 292

OBJ: Define the purposes of tertiary care. TOP: Tertiary Care

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

13. Which of the following is an example of a responsible resource manager in an acute care facility?

a.

Listens to staff input about implementing a new procedure

b.

Consumes foods and drinks kept on the unit for patients

c.

Considers the units patient census when determining staffing

d.

Uses supplies that are not accounted for

ANS: C

Nurses are responsible for recognizing that limited funds are available to provide acute health care. Within limits set by administration, staffing mixes, and restrictions on equipment and supplies, the RN must provide the patient with consistently safe and effective care, including managing resources. Listening to staff input is an example of a democratic-style of leadership, not a way to manage resources. Staff consumption of patients nutrition items and failure to bill for supplies used for patient care are examples of poor resource management.

DIF: Cognitive Level: Application REF: Pages 290-291

OBJ: Identify outcome priorities for secondary care.

TOP: Managing Secondary Care: Clinical Pathways

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

14. Spiritual assessment is not usually a part of a formal assessment tool, with the exception of asking about religious practices that may be important to continue in the hospital. Which question addresses religious practices?

a.

Would you like a chaplain to come pray with you?

b.

Do you turn to spiritual guidance as a source of strength in illness?

c.

What helps you most when you feel afraid?

d.

What is most frightening about your situation?

ANS: A

Asking about a chaplain is assessing whether the patient requires a spiritual guide by his or her side. Religious beliefs may affect the patients willingness to participate in the medical plan of care. The plan of care must be respectful of the patients beliefs while still providing the optimal environment for recovery. Asking about spiritual guidance as a source of strength, what helps most when afraid, and what is most frightening are not specific to religious beliefs.

DIF: Cognitive Level: Application REF: Page 288

OBJ: Analyze factors influencing patient outcomes.

TOP: Managing Secondary Care: Spirituality

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. In what way(s) do clinical pathways help nurses to manage patient care? (Select all that apply.)

a.

Evaluate long-term care facilities.

b.

Enable consistently safe care.

c.

Manage the resources of the health care facility.

d.

Define standard assessment data and frequency for data collection.

e.

Review patient charts for quality improvement opportunities.

ANS: B, C, D

A clinical pathway is a standardized care map that defines nursing care, outcome criteria, and evaluation time frames for specific disorders. Clinical pathways are designed to manage the resources of the health care agency, as well as enable consistent, safe care for patients. A clinical pathway defines the standard assessment data and frequency of the collection of the data needed for a specific illness or surgical procedure. The responsibility of the RN is to evaluate the effectiveness of the plan of care and the patients progress toward discharge. Evaluation of long-term care facilities and reviewing of patient charts for quality improvement are not discussed.